A Case of Large Cell Neuroendocrine Carcinoma of the Colon / 대한소화기학회지

Neuroendocrine carcinoma of the colon can be classified into small cell carcinoma and large cell neuroendocrine carcinoma. The incidence of neuroendocrine carcinoma is so low that the guideline for the treatment of large cell neuroendocrine carcinoma of the colon are not established. The prognosis of large cell neuroendocrine carcinoma of the colon is worse than that of conventional adenocarcinoma of the colon. We report a case of large cell neuroendocrine carcinoma of the colon that treated with right hemicolectomy and 6th sequential combination chemotherapy of 5-fluorouracil and cisplatin. There has been no evidence of the recurrence or metastasis of tumor for 6 months.

Littoral Cell Angioma (LCA) Associated with Liver Cirrhosis

A littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen. A 60-year-old man, with multiple nodules in imaging study and liver cirrhosis graded as Child-Pugh classification class A, was transferred for splenomegaly. A thrombocytopenia was found on hematological evaluation. Because there was no evidence of hematological and visceral malignancy, a splenectomy was performed for a definitive diagnosis. The histological and immunohistochemical features of the splenic specimens were consistent with a LCA. After the splenectomy, the thrombocytopenia recovered to the normal platelet count. There has been no previous report of a LCA combined with liver cirrhosis. Herein, the first case of a LCA in Korea, diagnosed and treated by a splenectomy, is reported.

The Methicillin - Resistant Rate of Staphylococcus Aureus Isolated from the Nares and Throat of Patients Admitted to Medical Intensive Care Unit / 결핵및호흡기질환

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in hospital-acquired infection, and is prevalent in intensive care units (ICU). The MRSA colonization rates of the nares and throat were examined in both the ICU and general ward. This study was performed to investigate the MRSA rate and necessity for MRSA screening cultures in patients admitted to ICU. METHODS: Between June and September 2004, those patients admitted to both the medical ICU and general ward participated in this study. Bacterial cultures were performed on swabs of the nares and throat taken within 24 hours of admission. Clinical data were also collected. RESULTS: One hundred and twenty one patients and 84 patients, admitted to the medical ICU and medical general ward, respectively, were investigated. The numbers of nasal MRSA colonization in the ICU and general ward were 3 (2.5%) and 3 (3.6%), respectively. There were 2 (1.7%) cases of throat MRSA colonization in the ICU, but none in the general ward. The MRSA colonization rates of the nares and throat were no different between the ICU and general ward. There were no significant differences in the previous admission, operation history and admission route between the ICU and general ward groups. CONCLUSION: The MRSA colonization rates of the nares and throat were 3.3 and 3.6% in the ICU and the general ward, respectively. The MRSA screening test does not appear to be required in all patients admitted to the ICU, but further studies, including high-risk patients, are recommended.

Delivery of Dialysis Dose of Intermittent Hemodialysis in the Patients with Acute Renal Failure and its Contributing Factors / 대한신장학회잡지

BACKGROUND: Recent studies have suggested that the outcomes of the patients with acute renal failure (ARF) may related to delivered dose of dialysis. In such context, a number of investigators have reported about delivered dose of dialysis and its contribution to outcomes of ARF, using Kt/V. The purpose of the study was to evaluate actual delivered dose of dialysis in intermittent hemodialysis (HD) in critically ill ARF patients, clinical factors contributing delivery of dialysis dose, and relationship of delivered dialysis dose and survival. METHODS: Delivered and prescribed dose of dialysis, presented as Kt/V, were measured in ARF patients intermittent HD in intensive care unit of Inha University Hospital from January 1999, until December 1999, using single pool urea kinetic model. RESULTS: All subjects received intermittent HD of 6.4+/-4.8 times with mean of 225.6+/-40.4 min per session. Overall survival was 55.5%. Prescribed Kt/V in all subjects was 1.24+/-0.39, but actual delivered Kt/ V was 1.08+/-0.17. A mean delivered/prescribed Kt/V ratio was 87.1+/-43%. Duration of HD session (R= -0.547, p=0.019), Cleveland Clinic Foundation Severity Score (R=-0.486, p=0.041), and frequency of hypotensive episodes (R=-0.419, p=0.043) were significantly correlated with delivered/prescribed Kt/V ratio. Delivered dose was under 1.2 in 66.7% of the subjects. Survival rate of these patients was 50.0%, which was lower as compared to 66.6% of the patients with delivered dose over 1.2. Patients with low delivered dose (Kt/V<1.2) showed significantly low prescribed dose and short HD time (p<0.05). Delivered Kt/V was correlated with BUN at initiation of dialysis, HD duration, and prescribed Kt/V (p<0.05). Non-survivors showed significantly low initial serum creatinine, low CCF severity score, high frequency of hypotensive episodes, and less use of heparin (p< 0.05). Prescribed Kt/V was not different between survivors and non-survivor (1.22+/-0.30 vs 1.31+/-0.45), but delivered Kt/V (1.17+/-0.17 vs. 1.04+/-0.17; p<0.05) and delivered/prscribed Kt/V (95.9+/-22.6% vs. 73.9+/-15.6%; p<0.05) were significantly higher in survivors than in non-survivors. CONCLUSION: In ARF patients, the delivery of dialysis was significantly lower than as was expected. Delivered/prescribed Kt/V was about 87% and more than half of the patients received intermittent HD of Kt/V less than 1.2. Better survival was associated with higher delivered dose of dialysis. We need further prospective studies about the causal relationship between delivered dose of dialysis and outcomes in ARF patients.

Antigenicity of an aphid allergen in respiratory allergic diseases / 천식및알레르기

BACKGROUND: Several inhalant allergens are newly identified from arthropods including insects or arachnids recently. Aphids (Heteroptera: Aphididae) are widespread sucking insects, which are parasitic on numerous host plants such as various crops, trees and weeds. Among aphids, Aphis gossypii is a particularly polyphagous species that has been described on almost 300 host plants from various botanical families. Thus A. gossypii is found throughout the country and is a species anyone can easily contact. It is unknown whether aphids have a role in the pathogenesis of respiratory allergy. OBJECTIVE: We assumed that aphids can act as an inhalant allergen on the hypothesis that numerous allergenic materials are released from aphids and become airborne. Using a representative species, A. gossypii, this study was performed to evaluate the antigenicity of an aphid allergen in patients with respiratory allergic diseases. METHODS: Skin prick test with crude extracts of A. gossypii and 50 common inhalant allergens was performed for 225 subjects with respiratory allergic diseases (bronchial asthma and/or rhinitis). A. gossypii-specific IgE (sIgE) were detected by means of ELISA, and IgE- binding components were identified by SDS-PAGE with immunoblot analysis. RESULTS: Of the 225 enrolled subjects, 37 (16.4%) subjects showed positive skin reactivity to A. gossypii. Of them, 17 (7.6%) subjects had A. gossypii-sIgE by ELISA. The SDS-PAGE of A. gossypii extracts showed various protein bands ranging from 9 to 200 kd. Of them, diverse IgE-binding pattern was noted for individual subject by immunoblot analysis. The inhibitory ELISA results indicated that IgE binding to A. gossypii was partially inhibited by the allergenic extracts of house dust mite (HDM), cockroach, or other aphid (Acyrthosiphon kondoi). Finally, A. gossypii-bronchial challenge test was conducted for one asthmatic farmer with skin reactivity to A. gossypii and strong job-related symptoms, but showed no significant response. CONCLUSION: A. gossypii can elicit IgE response in some patients with respiratory allergic diseases. A. gossypii may have a cross-reactivity with HDM and cockroach. Further study will be needed to evaluate its clinical significance in respiratory allergy patients.